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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> P?&r C Sc h ,rr / ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /C,(J7 t-( S t-Ii-.'t I P, -118 Variance(# ) <br /> HOME PHONE CELL PHONt E-MAIL ADDRESS <br /> fva-SA'-I?btl (rarIs CgJrd°irad4 era)cf$,C 1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT ,, PARCEL NUMBER: CURRENT ZONING:: ACREAGE: <br /> ❑PARCEL D h/13�, /9'60o 3 t� oZ•/) / a ( , frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> C_o}Ea e Grove• <o '/a: '7 <br /> '/+'/a: // ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> At/s J SUBDIVISION/6 BLOCK/LOT <br /> CSM: LOT <br /> E1 Sanitary permits <br /> 3 e DO (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: A - > �,Of <br /> 3 e-�n .5 �of r r r 1 Zoning I strict: . <br /> Mai r*_ -;x �;, <br /> This project is a new building or structure. 0 P r �' <br /> � Pe Itted se?`� � <br /> r <br /> ❑This project is an addition/alteration to an existing building or structure. - ' t ita <br /> SANITARY SERVICE: PERMIT NUMBER: rd(.4A d ss . �-, <br /> EWER EPTIC ' (IQUa tilt k <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /0l / CL Wetllan ood ain <br /> Sho and.(attac ment)F <br /> AREA TO NEAREST SQUARE FOOT: 1 :fkPSN- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) .` < <br /> BASEMENT: 1ST FLOOR: EroSlO Control permit <br /> 4, TOTAL SQUARE FOOTAGE: +, (slop�dlsturbance <br /> 2ND FLOOR: 3RD FLOOR: 2 q Q f Iltng/access) <br /> t <br /> Cl Review ocat,oti Survey <br /> ESTIMATED CONSTRUCTION COST: ,O Wand al able o ons. <br /> (Please round to nearest dollar) -♦ ♦ i�W � , 4:6V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes KNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes No ❑Don't know <br /> 7. Is this to correct a violation? ZYes EN <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -♦ -► <br /> 545-112(4/08) <br />